=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043034341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER SARISKY LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2024
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8575 RIXLEW LN
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20109-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-593-1315
-----------------------------------------------------
Fax | 301-681-4699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12073 TECH RD STE B
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20904-7874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-593-1315
-----------------------------------------------------
Fax | 301-681-4699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904007836
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------